Provider Demographics
NPI:1649329228
Name:CYRUS FOX, LISA J (LPCC-S)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:CYRUS FOX
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J CYRUS
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:38 OLD COACH RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3350
Mailing Address - Country:US
Mailing Address - Phone:740-517-4726
Mailing Address - Fax:
Practice Address - Street 1:38 OLD COACH RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3350
Practice Address - Country:US
Practice Address - Phone:740-517-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700.301-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional